Objectives: To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM. Methods: A prospective hospital based study using structured questionnaire was conducted between January to March 2015 at Karamara hospital, Jijiga, Ethiopia. All nulliparous women admitted for labor and delivery were included. Data were collected regarding circumcision status, events of labor, delivery; postpartum and neonatal outcomes as well as attitude of mothers towards elimination of FGM/C. Results: Two hundred sixty four (92.0%) of the women had FGM/C with most (93.0%) undergoing Type III FGM. The mean age of the women was 22 yr. Failure to progress in 1st stage and prolonged 2nd stage of labor occurred in 165 (57.0%) and 189 (65.6%) of the cases respectively. Caesarean section was performed in 17.0% and instrumental delivery in 23.0%. 64.5% required episiotomies, 83.3% had an anterior episiotomy, 29 % had perineal tears, 25.7%% experienced post-partum hemorrhage and 24% postpartum infection. Among the newborns, there were 6.4% perinatal deaths; 18.8 % low birth weight and 1.5% birth injuries. Almost all complications were more frequently seen in circumcised compared to non-circumcised women. Conclusions: The prevalence of FGM is high and it substantially increases the risk of many maternal complications. Health professionals should be aware of these complications and support/care of women with FGM should be integrated at all levels of reproductive health care provision. Capacity building of responsible health professional should be initiated in the area with intensification of FGM eradication activities.

Australian midwives’ perspectives on managing obstetric care of women living with femalegenitalcircumcision/mutilation

Ogunsiji O

ABSTRACT

Female genital mutilation (FGM) or female circumcision is a global health issue with increasing international migration of affected women and girls to countries unfamiliar with the practice. Western health care providers are unfamiliar with FGM, and managing obstetric care presents challenges to midwives who are in the forefront of care provision for the women. The participants in this Heideggerian qualitative interpretive study elucidated the strategies they used in overcoming the particular physical, emotional, and gynecological health issues with which mutilated women present. Ongoing emphases on women-centered, culturally competent maternity care are germane to optimal maternity care of circumcised women.

Since its inception, it has lobbied for a confidential national reporting system.

There were two reasons for this: the first is that as a group of clinicians, we could not provide effective evidence-based care for women if we did not know how many women had been subject to this abhorrent procedure; the second is that we wanted to provide clinical education for midwives, nurses, health visitors and doctors so that the best care can be provided to women.

With the support of Baroness Rendell, who has been raising questions in the House of Lords for nearly two decades, we met with Jane Ellison MP. It was a real meeting of minds and it was clear that, from this meeting, we would finally make progress when she agreed that it was nigh on impossible for us to address a problem in the UK without knowing the true extent of it….

BACKGROUND: Despite the World Health Organization campaigning to stop FGM, and it being illegal in many countries, the practice remains common in some countries and cultures. Migration has contributed to the growth of this practice in countries where it was not previously carried out.

DESIGN: Mixed-method synthesis.

DATA SOURCES: Search of ten electronic databases: 2006-2014. Manual scanning of reference lists and summary feeds from international organizations such as WHO, UN and UNICEF.

REVIEW METHODS: Thematic synthesis comparing country of origin where the practice was common with country of residence where migrant women affected by the practice reside. 17 included descriptive, quantitative, qualitative studies and grey literature studies in English or Spanish.

RESULTS: Seven themes were developed: Ignorance of FGM practice and its consequences; Lack of adherence to FGM protocols and guidelines; Socially constructed acceptance of FGM; Ignorance of legislation and legal status of FGM; Condoning, sanctioning or supporting FGM; Lack of information and training; Nurses and Midwives as key to protecting and supporting girls and women.

CONCLUSIONS: Although some nurses and midwives are in the forefront of eradicating FGM this is counterbalanced by health professionals (including nurses and midwives) who condone, sanction or support the practice with some calling for medicalization of FGM as a legitimate procedure. Girls at risk need better protection and women affected need more competent and cultural care from health professionals. Health and legal systems, professional regulation and governance, and professional training require strengthening to eradicate FGM, prevent the medicalization of FGM as an acceptable procedure, and to better manage the lifelong consequences for affected girls and women.

Female genital mutilation is a process that affects our practice. It is becoming more common in our ever-diversifying population and therefore education is vitally important to be able to put robust care plans in place. Understanding the psychological and physical difficulties experienced by women of childbearing age can help us to improve the care that we, as maternity healthcare professionals, can deliver. Looking at current research, this article examines some of the presumed cultural and societal beliefs behind the procedure and highlights some new evidence that change is welcomed by women and their families.

An explorative study of Sudanese midwives’ motives, perceptions and experiences of re-infibulation after birth

Berggren V, Abdel Salam G, Bergström S, Johansson E, Edberg A

ABSTRACT

Objective: to explore Sudanese midwives’ motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. Design: triangulation of methods, using observational techniques and open-ended interviews. Setting and participants: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. Findings: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. Key conclusions and implications for practice: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives’ potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.

A qualitative study of women’s lived experience after deinfibulation in the UK

Safari F

ABSTRACT

Objective: to explore women’s experiences of deinfibulation and its aftermath. Design: a qualitative study using semi-structured interviews with data collection via audio-recording and field notes. The audio-recorded interviews were transcribed verbatim and analysed using Interpretive Phenomenological Analysis (IPA) method for qualitative data analysis. Setting: recruitment for the study was carried out in an African Well Women Clinic in London, United Kingdom. Participants: there were nine women participants of Somali and Eritrean origin who had Female Genital Mutilation (FGM) type III previously and underwent deinfibulation between January 2008 and September 2009. Findings: key themes identified were the cultural meaning and social acceptability of deinfibulation; the consequences of deinfibulation within marital relationships; feelings about the appearance of genitalia post deinfibulation and thoughts on reinfibulation. Conclusions: marital factors and stability of the relationship influence the experience of deinfibulation. Those women who said they had discussed deinfibulation with their husband in advance, and that he had agreed to the procedure, reported less problems afterwards. Single women who had deinfibulation before marriage may face more difficulties in terms of social acceptability within their community. Implications for practice: sensitivity to social consequences of deinfibulation is important as well as recognition that these consequences vary. When deinfibulation is carried out for medical purposes some women may appreciate the offer of an official letter from a health-care practitioner confirming the medical nature of the procedure. The data suggests that deinfibulated women may dislike the new appearance of their genitalia; therefore, the practicality of performing a concurrent minor cosmetic surgery with deinfibulation procedure may need to be examined. The need for further research conducted in women’s primary language is pressing and should explore issues such as the situation of single women, men’s knowledge of the complications associated with FGM and the benefits of deinfibulation for infibulated women.

Objectives: to audit clinical management of women with type III female genital mutilation (FGM) according to local guidelines. Secondary objectives were to describe the population that uses the service and compare obstetric outcomes of intrapartum deinfibulation and antenatal deinfibulation. Design: retrospective audit. Setting: a hospital midwifery-led FGM specialist service in Birmingham, UK. Participants: 253 women with type III FGM who gave birth between January 2008 and December 2009 Methods: retrospective case analysis using patient records. Main outcome measures: proportion of women managed according to locally agreed criteria for the management of FGM; obstetric outcomes including perineal tears, episiotomy rates, estimated blood loss, infant APGAR scores and indications for caesarean section. Findings: 91 (36%) women booked into antenatal care after 16 weeks gestation. Only 26 (10.3%) were managed fully according to guidelines. The area with poorest performance was child protection, where the presence of normal genitalia was documented in only 52 (38.8%) of medical notes following birth of a female infant. The majority of women (214, 84.6%) had been deinfibulated in a previous pregnancy. Of the 39 infibulated at booking, only 9 (23.1%) were deinfibulated antenatally, the rest opted for intrapartum deinfibulation. Women who had intrapartum deinfibulation had a higher average blood loss and more tears than those deinfibulated antenatally, although this was not statistically significant. Conclusions and implications for practice: alternative systems should be considered to improve documentation of child protection related information. Further research is needed to confirm or refute the adverse findings among those that delayed deinfibulation.